power wheelchair to ambulate in their home despite the fact that such...The entire claim review process is far too subjective when objectivit...Tyler Wilson president and CEO of the American Association for Homeca...Wil...

power wheelchair to ambulate in their home, despite the fact that such forms are universally used in medicine. Physicians must "write" their prescriptions and not even a beneficiary's name can be pre-printed. Claims are also being denied if the physician's signature is not legible. More importantly, CMS has ordered that "clinical inference" can't be considered by claim reviewers, meaning that physicians must document every specific element of the algorithm in patient clinical records or claims will be denied. This change, as well as the others cited, are being applied retroactively during audits and are contributing to the high number of denials.

The entire claim review process is far too subjective, when objectivity is needed. Physicians are not trained to document information the way that CMS is requesting it, they aren't compelled to change and what CMS is asking is contrary to their common practices. Furthermore, the rules of the game keep changing, and mobility providers, Medicare beneficiaries and physicians become more and more frustrated with the process. "Instead of helping me in my mission to keep my patients functional at home, CMS or Medicare throws stumbling blocks in my way at every turn it seems," laments Dr. Jerald Winakur, M.D., F.A.C.P., C.M.D., a Clinical Professor of Medicine at the Center for Medical Humanities and Ethics at the University of Texas.

Tyler Wilson, president and CEO of the American Association for Homecare, said that CMS can't expect physicians to follow rules and regulations that they don't understand. "Two things are apparent," Mr. Wilson said. "Some of the things that CMS is asking of the nation's physicians are unreasonable considering the technology that we have available today, and there absolutely must be broader and more effective outreach that educates physicians on how to comply with the rules. The doctors are refusing to buy into a system that doesn't make much sense to them."

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